Is This the Real ‘Contagion’?

Is This the Real ‘Contagion’?

Children playing along a river bank spot hundreds of bloated pig carcasses
bobbing downstream. Hundreds of miles away, people are grossed out by the
rising stench from thousands of dead ducks and swans piling up along river
banks. Meanwhile, three unrelated humans stagger into three different
hospitals, gasping for air. Two quickly die of pneumonia and the third lies
in critical condition in an intensive care unit.

It's the classic scenario for the birth of a global pandemic. And
it's in the news today from China.

Last week, I wrote about the 16,000 pigs (so far) who'd been found
floating down the river through Shanghai. And the 1,000 ducks.

I didn't mention the three humans who'd been admitted to hospitals in the
region, gasping for air, two of whom died quickly while the third remains,
as of this morning, in intensive care.

Today, in Foreign Policy magazine, Pulitzer Prize-winning journalist
Laurie Garrett connects the dots in a red-alert global warning entitled "Is
This a Pandemic being Born?" (Subscription may be required.)

Garrett, a senior fellow for global health at the Council on Foreign
Relations, provided much of the science background for the movie Contagion.
She knows her stuff. She writes upfront that we don't know much yet, but
that we are certainly looking at a new virus, H7N9. It's possible that we're
simply witnessing something that's already run its course and has affected
very few people. It's equally possible that we're witnessing the birth of
something very dangerous to humankind.

Initially, the dead pigs and ducks looked to most people like just
another environmental horror along the banks of rivers that are already
shockingly polluted. The pigs might just have been dumped, like so much
other toxic garbage, by factory farms and pig brokers upstream.

But by the end of March, at least 20,000 pigs and tens of thousands of
ducks and swans had washed upon riverbanks that stretch 1,500 miles from
Lake Qinghai along the Sichaun River. And Lake Qinghai is a key site for
people investigating bird flu. Garrett writes:

The lake is the most important transit and nesting
site for migratory aquatic birds that travel the vast Asia flyway,
stretching from central Siberia to southern Indonesia. In 2005, a mass
die-off of aquatic birds in and around Lake Qinghai resulted from a
mutational change in the long-circulating bird flu virus, H5N1 -- a genetic
shift that gave that virus a far larger species range, allowing H5N1 to
spread for the first time across Russia, Ukraine and into Europe, the Middle
East and North Africa -- it has remained in circulation across the vast
expanse of Earth for the last seven years.

Thousands more birds and pigs may have have died without being counted –
perhaps buried or burned by farmers wanting to keep them out of sight of the
authorities.

Around the same time as the first pigs and birds were seen dead, three
people were admitted to separate hospitals. First Li, an 87-year old
retiree, was hospitalized in Shanghai with severe respiratory distress and
pneumonia. On March 4, he went into severe cardio-respiratory failure and
succumbed. Around the same time:

A 27-year-old butcher or meat processor [named Wu]
fell ill with respiratory distress, was hospitalized, and died on March 10.

The day Wu succumbed, a third individual, a
35-year-old woman identified as Han, was hospitalized in the city of
Nanjing, though she came from distant Chuzhou City, in Anhui province, about
300 miles northwest of Shanghai. Han is reportedly in critical condition, in
intensive care. To date, no connection between the three individuals has
been found.

The elderly Li may have been part of a family cluster
of illness, as his 55-year old son died of pneumonia in March, and another
67-year-old son suffered respiratory distress, but has survived.

China's new National Health and Family Planning Commission has now
announced that all three humans were infected with H7N9, a virus never
previously found in humans. Garrett writes:

It is therefore extremely worrying to find two people
killed and one barely surviving due to H7N9 infection.

One very plausible explanation ... is that the H7N9
virus has undergone a mutation -- perhaps among spring migrating birds
around Lake Qinghai. The mutation rendered the virus lethal for domestic
ducks and swans. Because many Chinese farmers raise both pigs and ducks, the
animals can share water supplies and be in fighting proximity over food --
the spread of flu from ducks to pigs, transforming avian flu into swine flu,
has occurred many times. Once influenza adapts to pig cells, it is often
possible for the virus to take human-transmissible form. That's precisely
what happened in 2009 with the H1N1 swine flu, which spread around the world
in a massive, but thankfully not terribly virulent, pandemic.

If the pigs, people, and birds have died in China
from H7N9, it is imperative and urgent that the biological connection be
made, and extensive research be done to determine how widespread human
infection may be.

If [the two dead humans] are a "two of three,"
meaning two dead, of three known cases, the H7N9 virus is very virulent.

... The mystery is deep, the clock is ticking, and
the world wants answers.

If we were imagining how a terrible pandemic would
unfold, this could certainly serve as an excellent script.

Yesterday, the Hong Kong government's Centre for Health Protection issued
a press release warning people about H7N9, including advice to, among other
things, avoid direct contact with birds and their droppings, and to avoid
crowded places and people with fevers. The government also advises people
traveling to or from Hong Kong to monitor their own health and report any
flu symptoms to a doctor immediately.

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